Therapeutic study, level III.

Objectives: The objective of this study was to assess medical students' knowledge of and attitudes toward the two Canadian emergency medicine (EM) residency programs (Fellow of the Royal College of Physicians of Canada [FRCPC] The majority of respondents (54.1%) interested in EM believed that there should be two streams to EM certification, whereas 18.0% disagreed. Family life and control over work schedule appeared to be common priorities seen as benefits of any career in EM. Other high-ranking factors influencing career choice differed between the groups interested in CCFP-EM and FRCPC. The majority of students interested in the CCFP-EM residency program (78%) reported that they intend to blend their EM with their family medicine practice. Only 2% of students planned to practice only EM with no family medicine. Conclusions: This is the first survey of Canadian medical students to describe disparities in factors influencing choice of EM residency stream, perceptions of postgraduate work life, and anticipated practice environment. La plupart des ré pondants (54,1 %) inté ressé s par la MU estiment qu'il devrait y avoir deux cheminements menant à la certification en MU, tandis que 18,0 % des ré pondants é taient en dé saccord. La vie de famille et le contrô le des horaires de travail semblaient ê tre des priorité s communes et constituer des avantages connus et recherché s dans toute carriè re en MU. Une diffé rence a é té observé e relativement aux autres facteurs ayant une trè s grande influence sur le choix de carriè re entre les groupes inté ressé s par le CCMF-MU et le FRCPC. La plupart des é tudiants inté ressé s par le

BackgroundAcute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons. Despite the recent emergence of this model of care, minimal research has been conducted on the quality of patient handover and no research has attempted to determine the rate of clinical agreement or disagreement among surgeons participating in these teams.MethodsA prospective cohort study was carried out with our acute care surgical service at a tertiary care teaching hospital from January 2 to March 31 2012. At the conclusion of the daily morning handover, receiving surgeons were asked to indicate, on provided handover sheets, whether they agreed with the proposed management plan for each patient that was discussed. The specific aspects of care over which they disagreed were also described, and disagreements were classified a priori as major or minor. The primary outcome was the rate of disagreement over the handed over management plan.ResultsSix staff surgeons agreed to participate and a total of 417 unique patients were handed over during the study period. For the primary outcome, a total of 41 disagreements were recorded for a disagreement rate of 9.8 %. 15 of the 41 disagreements were classified as major, for a major disagreement rate of 3.6 %. Consultant to consultant disagreements were classified as major disagreements 63 % of the time, whereas consultant to resident disagreements were classified as major 31 % of the time (P = 0.217). On average, the age of patients for which a clinical disagreement occurred were older; 63 vs. 57 (P < 0.05).ConclusionsDespite the frequency of handovers in clinical practice, little research has been conducted to determine the rate of disagreement over patient management among surgeons participating working in academic centers. This study demonstrated that the rate of clinical disagreement is low among surgeons working in an tertiary care teaching hospital.

Blunt thoracic injuries are commonly treated in the ICU and a solid knowledge of mechanical ventilation strategies (both noninvasive and invasive) is essential. Blunt thoracic aortic injuries require early diagnosis and aggressive blood pressure management. Not all such injuries need operative repair but those that do benefit from an endovascular approach. The management of flail chest includes early aggressive multimodal analgesia, adequate oxygen, and ventilatory support. Surgical rib fixation should be considered in select patients.